Marshfield boosts care, saves Medicare $83M

By Bernie Monegain
09:17 AM

Central to its performance, say Marshfield executives, is its electronic health record system.

The Marshfield Clinic system provides patient care, research and education with 52 locations in northern, central and western Wisconsin, making it one of the largest comprehensive medical systems in the United States.

The Centers for Medicare and Medicaid Services demonstration project challenged the participating physician practices to prove that providing high quality, coordinated healthcare could also save money.

CMS officials announced last December that, in the fourth performance year of the five-year Medicare demonstration project, the Marshfield Clinic again improved the quality of healthcare it delivers to patients while decreasing healthcare costs.

"It has taken a lot of hard work by clinic staff as we continually strive to improve care, but that work has been rewarded as the clinic this year exceeded 100 percent of the quality measures," said Theodore A. Praxel, MD, Marshfield’s medical director for quality improvement and care management. "We're pleased to show, for a fourth year, our success in efficiently using healthcare resources for the benefit of all the patients we serve, but we will continue to look for other ways to improve."

The Marshfield Clinic is one of two of the 10 participating practices to achieve this milestone in each of the four performance years. Because of this success, the clinic has so far saved the Medicare program more than $83 million over the four performance years reported.

"Marshfield Clinic has believed for a number of years that if we were to be successful in decreasing costs and further improving the quality of care delivered to patients, we would need to look at how we can deliver care in new ways," said Praxel. "This is why we committed to be a part of the Physician Group Practice Demonstration project."

While all participating group practices showed lower growth in Medicare expenditures collectively in the fourth performance year, the Marshfield Clinic was one of five to generate significant savings under the terms of the demonstration that resulted in a performance payment. The sites, aside from the Marshfield Clinic, that received performance payments are the Dartmouth-Hitchcock Clinic in Bedford, N.H.; the Geisinger Health System in Danville, Pa.; the St. John's Health System in Springfield, Mo.; and the University of Michigan Faculty Group Practice in Ann Arbor, Mich.

"The clinic is receiving a bonus payment of about $16.15 million, which will be used to fund further changes and improvements in how Marshfield Clinic delivers care to all of our patients," Praxel said. "The performance payment Marshfield Clinic receives will allow us to continue beneficial healthcare activities that are not currently reimbursed by most insurers right now."

The Marshfield Clinic had developed tools to improve quality of care delivered to patients prior to this project. including:

• All Marshfield physicians have access to patient records from all clinic centers through an electronic health record, which helps to eliminate duplication of services, such as lab tests and imaging. The EHR helps plan visits, addresses care at the time of the visit and assures appropriate monitoring of chronic conditions is performed.

• A 24-7 telephone nurse line for advice and triage for patients who have a primary care provider within the Marshfield Clinic system.

• An anticoagulation clinic.

• Congestive heart failure clinic programs.

• Cholesterol management programs.

• A well established telemedicine initiative.

Changes implemented as a result of participation in the demonstration project are not limited to Medicare beneficiaries, but are applied to all Marshfield Clinic patients.

"While this work is difficult, it is an important part of healthcare reform and it proves that we can reduce costs without compromising the high quality care all of our patients receive at Marshfield Clinic,” said Karl Ulrich, MD, the clinic’s president and CEO.

In this fourth performance year, the Marshfield Clinic has more than 35,000 people assigned by CMS, the largest group of beneficiaries in the project, which serves about 225,000 participants.

"We're delighted that the care delivery approach we instituted has been successful in providing quality care to patients as well as savings to CMS in all four years of the project," said Marilyn A. Follen, a nurse and administrator of quality improvement and care management at the Marshfield Clinic. "The outstanding efforts of our physicians and staff during the fourth performance year allowed Marshfield Clinic to improve the efficiency of care delivery and to exceed 100 percent of the quality measures set by CMS. This resulted in more than $35 million in savings to CMS in the fourth year. These results speak well for the dedication and hard work of all clinic physicians and staff members."

CMS Demonstration Project results being reported measure the fourth year from April 1, 2008, to March 31, 2009. During that year, participating large group practices reported 32 measures for diabetes, congestive heart failure, coronary artery disease, hypertension and cancer screening. In that year, three of the 10 sites met all 32 quality measures.

The CMS Physician Group Practice Demonstration project, extended a fifth year, concluded March 31, 2010.